Original article: general thoracic
Complicated hydatid cysts of the lung: clinical and therapeutic issues

https://doi.org/10.1016/j.athoracsur.2003.09.046Get rights and content

Abstract

Background

The clinical presentation and the preoperative and postoperative complications associated with pulmonary hydatid cysts depend on whether the cyst is intact or ruptured. The aim of this study was to review the problems encountered in treating ruptured pulmonary hydatid cysts and to highlight the risks associated with chemotherapy and the delay of surgical treatment in pulmonary hydatid disease.

Methods

The medical records for 67 patients of pulmonary hydatidosis were retrospectively investigated. The patients were divided into two groups based on whether the pulmonary cyst was intact (group 1, n = 34) or complicated (group 2, n = 33). A complicated cyst was defined as one that had ruptured into a bronchus or into the pleural cavity. All patients were treated surgically. Data related to symptoms, preoperative complications, surgical procedures performed, postoperative morbidity, hospitalization time, and cyst recurrence were collected from each individual's records, and the group findings were compared.

Results

In most cases of intact pulmonary hydatid cysts, the lesions were either incidental findings or the patient had presented with cough, dyspnea and chest pain. In addition to these symptoms, the patients with complicated cyst had presented with problems such as expectoration of cystic contents, repetitive hemoptysis, productive sputum, and fever. The differences between the groups with respect to the rates of preoperative complications and postoperative morbidity, frequency of decortication, and hospital stay were statistically significant (p < 0.05).

Conclusions

Surgery is the primary mode of treatment for patients with pulmonary hydatid disease. Complicated cases have higher rates of preoperative and postoperative complications and require longer hospitalization time and more extensive surgical procedures than uncomplicated cases. This underlines the need for immediate surgery in any patient who is diagnosed with pulmonary hydatidosis.

Section snippets

Material and methods

The medical records of 67 patients with pulmonary hydatid cysts who had operations for the same at our center between January 1998 and December 2002 were reviewed. The series included 33 males and 34 females with a mean age 34 years (range, 4 to 75 years). Approximately 80% of the patients lived in rural areas. The follow-up times for all 67 patients ranged from 5 months to 5 years.

The pulmonary cysts were diagnosed by various combinations of chest roentgenogram, thoracic ultrasonography, and

Results

Assessment of clinical findings, chest roentgenograms, thoracic computed tomography, and thoracic ultrasonography led to the correct preoperative diagnosis of pulmonary hydatid disease in 63 patients (94%). The other 4 patients were diagnosed intraoperatively. In 3 of these patients, the respective misdiagnoses before surgery were cavitary tuberculosis with associated fungus ball, malignant tumor, and solitary pulmonary nodule. In the other patient, a suppurative cyst attached to the posterior

Comment

In most uncomplicated cases of pulmonary hydatid disease, lung cysts are either an incidental finding or the patient presents with cough, dyspnea, and chest pain. With complicated cysts, the clinical picture is variable and depends on the nature of the perforation. Often the cyst ruptures into a bronchus. In most cases, solid remnants of the collapsed parasitic membrane are left in the cavity as a source of recurrent infection 1, 5, 6, 7. Such patients present with all the previously described

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Copyright © 2004 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.